A MRCGP SCA station on MedMock, start to finish

Hello, come in and have a seat. I'm Dr Evans, one of the GP trainees here. Can I just check your full name and date of birth, please? And what can I do for you today?

Leon Fraser, thirty-first of January, seventy-six. So I turned fifty this year. I'm here about some blood test results, apparently something's a bit off with my sugar levels, my son Jay's been on at me about it more than the doctor's letter, to be honest.

Thanks, Mr Fraser. It sounds like Jay is keeping an eye on you. Before I go through the results, could you tell me a bit about what you understood from the letter, and what's been going through your mind about it?

Honestly, the letter said something like my sugar's a bit high, not full-on diabetic yet, but heading that way if I don't sort myself out. I didn't really understand the number they used. Jay looked it up and started going on about how I'll end up on insulin like his nan, which frightened me a bit if I'm honest.

That's completely understandable, especially having seen what his nan went through. I'll come back to that, because I think I can reassure you on a few things. First, have you noticed anything different lately, like being more thirsty, passing water more often, especially at night, losing weight without trying, feeling unusually tired, or getting infections that are slow to clear?

Not that I've noticed, no. I've not lost any weight, and I'm not up in the night for the toilet or anything like that. Tired, maybe, but I put that down to the driving hours and the odd hours I keep, not sure it's anything new really.

That's helpful, thank you. Tell me a bit about the driving, what sort of work is it and what are your days like, including when and what you tend to eat? And on the tiredness, does anyone say you snore heavily or stop breathing at night, or have you ever felt yourself nodding off at the wheel?

Driving's minicabs, my own firm actually, so I'm in and out the office as much as behind the wheel, but the hours are long. Eating's a mess if I'm honest, whatever's quick, chicken shop, kebab, bit of a fry-up when I'm home. Nobody's said I snore or stop breathing, no, and I've not nodded off driving, thank God, that would worry me more than anything.

Good, I'm glad about that. A few quick questions that all feed into this. How much alcohol do you drink in a typical week, do you smoke, and do you get any exercise at all? And Jay's nan, was that your mum, and does anyone else in the family have diabetes or heart problems? Are you on any medicines at the moment?

Alcohol's not much, maybe a beer or two most nights, so I don't know, six or eight cans a week? I don't smoke cigarettes, I'll have the odd cigar with the lads, doesn't feel the same though. Exercise, if I'm honest, hardly any, used to play five-a-side but that stopped years ago. Yeah, Jay's nan is my mum, she's on insulin, and my dad had a heart attack in his sixties. I'm not on any tablets myself, nothing regular.

Thank you, that gives me a really clear picture, and I'm sorry to hear about your mum. Before I explain what the results mean, what were you hoping we'd get out of today? Was there anything in particular you wanted from me?

Honestly, I just want to know if this is something I can turn around myself, without going on tablets or anything like that. I'd rather sort it with diet and that if I can. And I suppose I want to know how worried I should actually be, because between the letter and Jay's googling I've been picturing the worst.

So the good news first: you don't have diabetes. The test, called HbA1c, is an average of your sugar over about three months. Yours is 45, and diabetes starts at 48, so you're in what we call the pre-diabetes range. That's a warning light rather than a diagnosis, and yes, this is very often something people turn around themselves with diet, activity and losing some weight, without tablets. The scan also showed some fat in the liver, which usually comes from the same things, so the same changes help both. Does that make sense so far?

That makes sense, yeah. So it's not diabetes, that's a relief at least. But the liver thing, that's new to me, nobody's said anything about my liver before — is that serious?

It's a fair question. Fatty liver is very common, and caught at this stage it can improve, even reverse, with weight loss. The thing we want to rule out is scarring, so I'd like to do a blood test that looks for that, along with your liver tests and cholesterol, which also lets me work out your heart risk given your dad. If anything shows scarring we'd arrange a specialist scan or referral. Keeping the beer modest, with a few alcohol-free days, helps the liver too.

That does sound sensible, yeah, better to know than not. Just doing it as a normal blood test, or do I need to come back in for that?

Just a normal blood test with our nurse or phlebotomist, no need to fast, and you can book it at the desk on the way out. For the sugar and the liver, there are a couple of options. I can refer you to the NHS Diabetes Prevention Programme, which is free and gives support with food, activity and weight, either in a group or through an app on your phone, which might fit better around your hours. Alongside that, small swaps that work on the road, like packing something rather than the chicken shop, and a daily brisk walk. Which of those sounds doable for you?

I'd say the walking's more realistic than any app, I'm not really one for typing food into a phone all day. Packing something instead of the chicken shop, yeah, I could actually do that, box up some rice and chicken the night before maybe. Group sessions I can't really do with my hours, but if there's an app version that don't need me sat there at a set time, I'd give that a go.

That sounds like a really good plan, and it's yours, which is what makes it stick. So I'll refer you for the app version, you'll do the blood test this week, and we'll speak in a couple of weeks to go through the results and your heart risk. Then we'll repeat the sugar test in about three months, and at least yearly after that. In the meantime, if you get very thirsty, are up at night passing water, lose weight without trying, or notice yellow eyes or skin or a swollen tummy, please don't wait, book in sooner. Just so I know I've explained it properly, could you tell me in your own words what you'll say to Jay tonight?

I'll say I've been told to walk more and pack proper food instead of the chicken shop, and that it's not full diabetes yet, so if I get on top of it now I can turn it round without any tablets. I'll tell him there's an app coming to help, and I'm getting more bloods done to check the liver and my heart risk. Should shut him up a bit, though knowing Jay he'll still be checking up on me every five minutes.

That's spot on, and you can tell Jay that insulin is a long way from where you are today, and the changes you're making are exactly what makes that less likely. Having him in your corner is no bad thing either. Is there anything else you wanted to ask before you go? Lovely, then book the bloods at the desk, and I'll speak to you in a couple of weeks. Take care, Mr Fraser.

Nah, think that's covered it. Cheers for going through it properly, actually — makes a lot more sense than the letter did. I'll get the bloods done on the way out.